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NAVAL HEALTH RESEARCH CENTER

Marine Corps Casevac:

Determining Medical Supply Needs For Long- and

Short-Range Airborne Casualty Evacuation

M. Hill

M. Galarneau

G. Pang

P. Konoske

Report 04-32

Approved for public release; distribution unlimited.

NAVAL HEALTH RESEARCH CENTER P. O. BOX 85122 SAN DIEGO, CA 92186-5122

BUREAU OF MEDICINE AND SURGERY (M2) 2300 E ST. NW

WASHINGTON , DC 20372-5300

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MARINE CORPS CASEVAC: Determining Medical Supply Needs

For Long- and Short-Range Airborne Casualty Evacuation

Martin Hill1

Mike Galarneau2

Gerry Pang2

Paula Konoske2

1GEO-CENTERS, INC. 2Naval Health Research Center 7 Wells Avenue, Suite 1 P.O. Box 85122 Newton, MA 02459 San Diego, CA 92186-5122 Technical Report No. 04-32 was supported by the Bureau of Medicine and Surgery, BUMED-M6, Washington, DC and the Marine Corps Systems Command, Quantico, VA, under Work Unit 63706N M0095.005-60304. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government. Approved for public release; distribution is unlimited. This research has been conducted in compliance with all applicable federal regulations governing the protection of human subjects in research.

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TABLE OF CONTENTS

Summary ................................................................................................................................iii

Introduction............................................................................................................................1

Method ...................................................................................................................................2

Results....................................................................................................................................4

Discussion and Comment ......................................................................................................5

References..............................................................................................................................7

Appendix A: CASEVAC Integrated Product Team Attendees .............................................A1

Appendix B: Identified Clinical Tasks for CASEVAC .........................................................B1

Appendix C: CASEVAC Medical Equipment and Consumables .........................................C1

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SUMMARY Problem Recent combat in Afghanistan and Iraq has seen the Marine Corps adopt a new concept in airborne casualty evacuation (CASEVAC). Historically, Marine Corps CASEVAC missions have been lifts of opportunity, in which wounded were evacuated by any available rotor-wing aircraft, regardless of whether it carried medically trained personnel. In recent years, the Marine Corps adopted a “designated” CASEVAC system in which certain aircraft are assigned casualty evacuation as one of their missions and are crewed by at least one field-qualified corpsman. However, the equipping and training of these corpsmen is currently done on an ad hoc basis, and differs from unit to unit. Objective In 2003, the Naval Health Research Center (NHRC) was tasked with analyzing and identifying the medical supply requirements for a long-range CASEVAC capability for the Marine Corps. This study was based on the requirements set forth in a Universal Need Statement filed with the Marine Corps Combat Development Command (MCCDC) by the 24th Marine Expeditionary Unit (Special Operations Capable). On August 3-5, 2004, MCCDC and the Marine Corps Systems Command organized an Integrated Process Team (IPT) meeting at Miramar Marine Corps Air Station to develop a statement of need (SON) for a combined short- and long-range CASEVAC capability. Method Thirty-one generic CASEVAC patient types were developed from the Defense Medical Standardization Board’s list of patient conditions. Treatment profiles were written for each patient type and medical supplies assigned to each task in the treatment profiles, establishing the clinical requirements for the CASEVAC supply blocks. A SON for a CASEVAC capability was written, based on the NHRC findings. The NHRC CASEVAC supplies and the SON were reviewed and modified as needed by an IPT consisting of senior CASEVAC corpsmen and medical directors. Discussion and Conclusion The NHRC study and subsequent expert review have provided the Marine Corps with the medical supplies needed to properly augment its designated CASEVAC aircraft in Iraq and elsewhere. Once deployed with specially trained CASEVAC corpsmen, the Marine Corps will have the capability to provide wounded Marines and sailors with intermediate to advanced casualty care, depending on the skill level of the individual corpsman, for prolonged transport times of up to 4 hours.

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MARINE CORPS CASEVAC: Determining Medical Supply Needs For Long- and

Short-Range Airborne Casualty Evacuation

INTRODUCTION Recent combat in Afghanistan and Iraq has seen the Marine Corps adopt a new concept in airborne casualty evacuation (CASEVAC). Historically, Marine Corps CASEVAC missions have been lifts of opportunity, in which wounded were evacuated by any available rotor-wing aircraft, regardless of whether it carried medically trained personnel. In recent years, the Marine Corps adopted a “designated” CASEVAC system in which certain aircraft are assigned casualty evacuation as one of their missions. By being designated a CASEVAC asset, an aircraft may perform other military missions – such as delivering troops or supplies to the front line – but that aircraft will carry as part of its crew one or two Navy corpsmen trained and equipped to treat wounded Marines if the aircraft is diverted to a CASEVAC mission.1 In addition to these “short-range CASEVAC” missions, the Marine Corps has identified a need for a long-range CASEVAC capability. Sea Power 21 doctrine calls for projecting U.S. military power from sea-based command platforms far into any future battle space, thus maintaining reduced personnel, equipment, and logistical footprints ashore. As part of this doctrine, the U.S. Marine Corps is developing capabilities to deploy and support combat troops for short-duration, high-maneuver missions — such as tactical recovery of aircraft and personnel (TRAP) missions — deep within enemy territory and far from shore.2 Included in this capability is the use of company-size (150 men) raiding parties from Marine Expeditionary Units (Special Operations Capable) [MEU (SOC)] for forays extending up to 400 miles from their over-the-horizon support units.3 Providing casualty evacuation in these combat environments presents special problems. Even troops patrolling at relatively short distances from forward operating bases may have difficulties evacuating casualties by ground to a surgical facility. Small mobile units operating at large distances from rear areas or sea-based platforms, such as TRAP missions, will not have the support of even an intermediate treatment facility such as a battalion aid station. At such distances, even evacuation by available air assets — such as the CH-53 Sea Stallion and the CH-46 Sea Knight and their variants — would be well outside the “golden hour” by which time trauma experts agree severely injured patients must receive some form of advanced lifesaving intervention.3, 4 The multi-service Committee on Tactical Combat Casualty Care determined that highly mobile battle tactics require a means of providing intermediate to advanced casualty care during CASEVAC missions, especially when transportation is prolonged or has been delayed.5 However, there is currently no official such asset in the Marine Corps warfighting inventory.

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As a result, Marine Corps units have developed ad hoc means of providing CASEVAC in Afghanistan and Iraq. The 24th MEU (SOC), for example, designated a CH-53 Sea Stallion as a long-range CASEVAC platform to provide advanced trauma life support for up to 16 wounded Marines.3, 4 During Operation Iraqi Freedom I and II, air elements of the 1st Marine Expeditionary Force developed a CASEVAC system utilizing available medical personnel, and the equipment and supplies designed for postsurgical en route care.1 Neither system of casualty evacuation can be supported with existing materiel and personnel resources.3 In 2003, the Naval Health Research Center (NHRC) was tasked with analyzing and identifying the medical supply requirements for a long-range CASEVAC capability for the Marine Corps. This study was based on the requirements set forth in a Universal Needs Statement filed with the Marine Corps Combat Development Command (MCCDC) by the 24th MEU (SOC).6 On August 3-5, 2004, MCCDC and the Marine Corps Systems Command organized an Integrated Process Team (IPT) meeting at Miramar Marine Corps Air Station to develop a statement of need (SON) for a combined short- and long-range CASEVAC capability. The IPT consisted of 16 subject matter experts (SMEs) representing senior CASEVAC corpsmen, physicians with CASEVAC medical direction experience, and medical logistics experts (see Appendix A). With so many combat-experienced medical experts available, a decision was made to use some of the IPT schedule as an SME panel for vetting NHRC’s proposed medical equipment and consumable list for CASEVAC missions.

Figure 1

NHRC Method of Modeling Medical Supplies

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P C 0 0 5 C e r e b r a l c o n t u s i o n , c l o s e d , w i t h in tr a c r a n ia l h e m o t o m a a n d n o n - d e p r e s s e d l in e a r s k u ll f r a c t u r e

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METHOD The 2003 NHRC study utilized the Center’s method of modeling medical supply requirements, which was developed to establish and/or review Authorized Medical Allowance Lists (AMALs) for various levels of care in the Navy and the Marine Corps. Its aim is to give clinicians in the field or the fleet the materiel they need to provide the best care possible, while still maintaining as small a logistical footprint as possible in concert with current Navy and Marine Corps doctrine.

It involves a four-step process that begins with the identification of likely patient types to be encountered by a particular type of medical treatment asset, including combat wounds, nonbattle injuries, and illnesses. Patient conditions (PCs) found in the Defense Medical Standardization Board (DMSB) treatment briefs are used for this purpose. The PCs are then linked to clinical tasks developed by DMSB and NHRC. Those tasks are, in turn, linked to each supply item needed to complete the task. Equipment and consumable supplies can then be calculated based on the probability of those PCs occurring in a patient stream. Figure 1 provides a basic representation of the NHRC modeling process. One hundred and ninety-nine PCs were identified as those most likely to be encountered by a CASEVAC medical crew. For modeling purposes, these DMSB PCs were distributed into 31 generic patient types divided into three categories – trauma, environmental injury, and illness. The underlying probability of the selected DMSB PCs occurring in a given battle was determined by running a patient stream containing the PCs through the NHRC Estimating Supplies Program, using a combined East-West battle scenario incorporating a Northeast Asia Heavy Battle Intensity and Southwest Asia Heavy Battle Intensity. This scenario was chosen to provide a robust patient stream for modeling. Once the probability of the individual PCs was determined, the underlying probability for each of the generic CASEVAC patient types was calculated. Figure 2 shows the 31 generic patient types and their probability of occurrence in a major East–West confrontation.6 Task profiles were created for each generic patient type. Task profiles include the unique clinical interventions required by each patient type, and establish a systematic sequence of clinical tasks to be performed by the attending corpsmen. Forty-nine clinical tasks were identified. These clinical tasks were compared with the 12 major categories of clinical skills recommended for CASEVAC care by the Committee on Tactical Combat Casualty Care and found to encompass all skill categories. A list of these clinical tasks can be found in Appendix B. Once completed, a patient stream of 16 patients was run against the supply set to yield the final quantities for each supply item.6

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Figure 2

Probability of Occurrence of CASEVAC Patient Types

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RESULTS The original NHRC study developed a proposed AMAL for a long-range CASEVAC mission involving a single helicopter carrying up to 16 patients, 2 of them critically wounded and requiring ventilator support. This was based on the requirements set out by the 24th MEU (SOC) based on its combat experience in Afghanistan.6 Since then, combat operations in Iraq have developed new requirements for shorter range missions. A decision was made among the IPT SMEs to develop a CASEVAC AMAL capable of providing short-range care to 8 casualties, including 1 critically wounded, 5 litter casualties and 2 ambulatory or “walking wounded.” Combining 2 of these AMALs, plus a small, long-range supplement, would provide a long-range evacuation capability for up to 16 injured Marines, including 2 critically wounded, 10 litter patients, and 4 ambulatory patients. Since current CASEVAC doctrine calls for 2 aircraft to fly in tandem at all times, these patients would most likely be split between 2 helicopters.7 The SON developed at the IPT meeting specifically set forth the level of care required for the CASEVAC mission. It lists as a Key Performance Parameter that the CASEVAC AMAL shall provide for long-range missions the “equipment and supplies for care of casualties who may require ventilator support, physiological monitoring, intravenous therapy, medication administration, supplemental oxygen therapy, airway maintenance,

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head and limb immobilization, hemorrhage control, management of infectious human & medical waste, and burn management material.”7 Personnel for long-range missions would be limited to search-and-rescue hospital corpsmen [Navy Enlistment Classification Code (NEC): 8401/8404], who already possess many of the advanced clinical skills required by the mission, as well as aircrew qualifications. For short-range CASEVAC missions, the SON specifies the use of medical specialist hospital corpsmen assigned to the Marine Corps (NEC 8401/8404, 8404, 8406, and 8409), some of whom may or may not have aircrew qualifications. Corpsmen for both missions will require additional training, though the extent of the training for both short- and long-range missions will depend on the individual corpsman’s existing level of training. Additional skills needed may include rapid sequence intubation, needle decompression of the chest, ventilatory support and more advanced pain control.7 Once the level of care and corpsmen skill levels were established, the SMEs turned to solidifying the AMAL. The AMAL developed for long-range CASEVAC missions by NHRC included several medications not normally used by corpsmen, but which were identified as necessary by the Committee on Tactical Combat Casualty Care.5, 6 Additional medications were added by the SMEs – physicians and corpsmen alike – as deemed necessary for the successful completion of the CASEVAC mission. Use of these medications will depend on the training and skill level of the individual corpsman and his or her medical direction. Table 1 lists these medications and their proposed use.

Table 1

Special Medications for CASEVAC Use

Medication Use Long or Short Range Mission

Morphine Pain control (major wounds) Both Promethazine* Antiemetic Both Ketorolac Pain control (moderate/minor wounds) Both Naloxone Reverse narcotic respiratory

depression Both

Cefotetan* Infection control Long range Gatifloxacin* Infection control Long range Diazepam Sedate agitated patients Both Dexamethasone Head injuries Long range Diphenhydramine Respiratory distress Long range Epinephrine Respiratory distress Long range Midazolam Rapid sequence intubation Both Succinylcholine Rapid sequence intubation Both Vecuronium Bromide Rapid sequence intubation Both Ketamine Rapid sequence intubation Both *Recommended by the Committee on Tactical Combat Casualty Care.

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Table 2 shows the final weight, cube, and cost distribution of the proposed CASEVAC AMAL, including the supplement supplies needed for long-range missions. The full list of CASEVAC medical equipment and consumables can be seen in Appendix C.

Table 2

CASEVAC Weight, Cube, and Cost

Equipment Weight 97.3 Cube 8.8286 Cost $5,027.67 Consumables Weight 70.18 Cube 9.64 Cost $4,568.98 Long-range supplement Weight 48.28 Cube 5.72 Cost $25,028.31 Combined Totals Weight 215.76 Cube 24.1886 Cost $34,624.96

DISCUSSION AND COMMENT The NHRC study and subsequent IPT and SME panels will provide the Marine Corps with the medical supplies needed to properly augment its designated CASEVAC aircraft in Iraq and elsewhere. Once deployed with specially trained CASEVAC corpsmen, the Marine Corps will have the capability to provide wounded Marines and sailors with intermediate to advanced casualty care, depending on the skill level of the individual corpsman, for prolonged transport times of up to 4 hours. The combined input of researchers and experienced CASEVAC personnel also identified areas of additional training needed for corpsmen involved in airborne CASEVAC. Establishing an official SON and CASEVAC AMAL will lead to standardization not only of equipment and supplies throughout the Corps, but also of training and skill sets for CASEVAC corpsmen. However, establishing the CASEVAC AMAL is not an end in of itself. The AMAL should be regularly reviewed and updated as experience on the battlefield reveals either success or failure of the AMALs component, or as new technology applicable to CASEVAC becomes available. This study and subsequent panels have proved NHRC’s

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method of researching and modeling is appropriate for conducting such ongoing reviews and updates.

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REFERENCES 1. Marine Corps Airborne CASEVAC Medical Manual June 28, 2004. 2. Clark V. Sea Power 21. Naval Institute Proceedings. 2002(October 2002). 3. Miller C, Lt., USN. Universal Needs Statement (UNS) Long Range Raid CASEVAC,

Originator's Request, Rev. 1-01. Quantico, VA: Marine Corps Combat Development Command; 2000.

4. Semple GJ, LCdr. Request for Approval of Proposed Equipment, Medicine and

Consumable Supply Lists for 22d MEU Combat Casualty Transport Teams. In: Surgeon IM, ed; 2002.

5. Tactical Combat Casualty Care: Prehospital Care in the Tactical Environment: The

Committee on Tactical Combat Casualty Care; 2003 (Draft):52. 6. Hill MR, Galarneau M, Pang G, Konoske P. Marine Corps CASEVAC: Determining

Medical Supply Requirements for Long-Range Casualty Evacuation Aircraft. San Diego, CA: Naval Health Research Center; 2003. 03-20.

7. Required Performance Characteristics for the Casualty Evacuation Aircraft

(CASEVAC): Marine Corps Combat Development Command; 2004.

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Appendix A: CASEVAC Integrated

Process Team Attendees

CASEVAC Integrated Process Team Attendees

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HMCM Alex Allayban MARCORSYSCOM allaybanab@mcsc.usmc.mil 703-432-3220 LT M. Aguilera 3rd MAW (MCAS Miramar) aguilerama@3maw.usmc.mil 858-577-9902 Chuck Bolin Project Integrator bolinct@jpoip.org 540-288-2440 HMC Rob Brown 2nd MAW (New River) brownre@2mawnr.usmc.mil 910-449-6500 ext. 249 HMC Jeff Carter 2nd MAW (Cherry Point) carterjh@2mawcp.usmc.mil 252-466-4376 HM2 Michael Chick 3rd MAW (Camp Pendleton) chicmr@3mawcpen.usmc.mil 760-725-4956 CDR Louis G. Gilleran, MC(FS) Naval Medical Center, San Diego gilleranlg@nmcsd.med.navy.mil Martin Hill Naval Health Research Center hill@nhrc.navy.mil 619-553-0478 HMCM Robert W. Johnson 2nd MAW (Cherry Point) johnsonrow@2mawcp.usmc.mil 252-466-2999

HMCM Joe Langholtz II MEF langholtzjb@iimef.usmc.mil 910-451-8685 HMC Len Miller 2nd MAW (New River) milll@2mawnr.usmc.mil 910-449-6500 ext. 251 LCDR Sharon Moser Marine Corps Warfighting Laboratory mosersl@mcwl.quantico.usmc.mil 703-432-0467 LCDR Bill Padgett 2nd MAW (New River) padgettws@2mawnr.usmc.mil 910-449-6500 ext. 250 HMC Thomas Spradlin NAS North Island Thomas.spradlin@navy.mil 619-545-5403 LT Henry Warren 3rd MAW (MCAS Miramar) warrenhs@3maw.usmc.mil 858-577-7438 LCDR Brian Wells 3rd MAW (Camp Pendleton) wellsbp@3mawcpen.usmc.mil 760-201-7012

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Appendix B: Identified Clinical

Tasks for CASEVAC

Appendix B: Identified Clinical Tasks for CASEVAC

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Task Task Description

002 Assessment and Evaluation of Patient Status 006 Establish Adequate Airway (Oro/Naso Pharyngeal only) 007 Emergency Cricothyroidotomy 010 Neurological Assessment 011 Stabilize Neck (Collar/Spine Board) 018 Recognize and Respond to Hemorrhage 022 O2 Administration Setup 023 O2 Administration Continuous (Nasal/Mask) 024 Vital Signs 032 Set-Up Pulse Oximeter 038 Maintain on Ventilator 049 Start/Change IV Infusion Site 050 Administer IV Fluid 070 Bowel Sounds Assessment 071 Insert NG/OG Tube 073 Perform NG/OG Suction 075 Irrigate NG Tube 079 Catheterization, Foley 082 Measure/Record Intake/Output 086 Clean and Dress Wound 088 Reinforce Dressings 091 Apply Ice/Hot Packs 096 Apply Sling 098 Apply Splint/Immobilize Injury 108 Minor Surgical Procedure (Debride/Suture/Incision) 123 Eye Care (Dressings/Eye Patch) 126 Seizure Care/Precautions 142 Document Appropriate Meds/Treatment 145 Administer Appropriate Medication A6 Apply Tourniquet

Z014 Endo/Naso-tracheal Intubation Z027 Cardio Arrest Resuscitation Z030 Electronic Monitoring of Patient Vital Signs (Propaq) Z037 Bag Valve Mask Setup Z039 Perform Ventilation with Bag Valve Mask Z083 Expose Patient for Exam Z094 Extremity Traction, Application/Adjust ZZ03 Needle Thoracostomy

Appendix B: Identified Clinical Tasks for CASEVAC

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Task Task Description ZZ19 Warm Infusion Fluids ZZ42 Patient Warming ZZ58 Rapid Pressure IV Infusion ZZ65 Conduct Patient Hand-Off ZZ67 Secure Patient to Litter/Airframe ZZ77 Assess Airway/Breathing ZZ80 Perform Suction (E-T Tube/Tracheostomy Tube) ZZ85 Reassess Tourniquet ZZ93 Manage Seizing Patient ZZ96 Assemble/Replenish/Resupply Materiel ZZ98 Preventive Maintenance, Checks, & Services of Equipment

Appendix C: CASEVAC Medical

Equipment and Consumables

NOMEN QTY UI TOT W TOT C TOT PRICE NSN EQUIPMENT

PN: LBTC-2209 Bag Aeromedical Large (Note: London Bridge) 1.00 EA 1 0.1 $241.43 PN: LBTC-2210A Bag Aeromedical Small (Note: London Bridge) 1.00 EA 1 0.1 $235.71

PN: 3802-000 Case Protective For Nonin Pulse Ox (Note: Nonin Medical) 2.00 EA 0.5 0.05 $50.00

6515012808163 Infusor Pressure Blood/Iv 14x6in 1000ml 2.00 EA 0.7 0.09 $24.38 6515013448487 Injector Tube Reusable 1ml & 2ml Ndl Units 2.00 EA 0.22 0.13 $8.62

PN: 563-8025 Knee Pads Tactical Black 1pr (Note: Blackhawk Industries) 2.00 PR 1 0.1 $28.54

6515014553888 Lantern Electric Head Mount Halo/Krypton 2.00 EA 1.1 0.24 $46.00 6515006165052 Laryngoscope Macintosh Child/Adult 4 Blade 2.00 EA 7.92 0.32 $111.00 6540014553885 Lens Cover Red Lantern Electric Head Mount 2.00 EA 1.1 0.24 $4.00 6530015049051 Litter Decontamination Black Folding 4.00 EA 44 4.4 $1,400.00 6515012530306 Mask Pocket Oronasal For CPR 2.00 EA 0.2 0.02 $32.34 6515014586178 Otoscope & Ophthalmoscope Set Deluxe Soft 2.00 EA 11.1 0.224 $560.00 6515014660971 Oximeter Pulse Finger Battery Op Nonin 2.00 EA 1.1 0.1 $700.00

PN: 60MP01OD Bag Medical Stomp2 Olive Drab (Note Blackhawk Industries) 2.00 EA 14 2 $599.90

6515012045394 Resuscitator Hand Operated High O2 2.00 EA 2.4 0.03 $303.00 6515009357138 Scissors Bandage 7.25in Angle To Hdl 2.00 EA 0.38 0.028 $4.00

PN: HEM-630 Sphygmomanometer Auto Digital Wrist (Note: Omron Corp.) 2.00 EA 1 0.1 $140.00

PN: 540712 Sphygmomanometer Manual One-Hand Illuminated Dial (Note:Boundtree Medical)) 2.00 EA 1 0.1 $59.90

6515013146694 Stethoscope Littman Classic Ii 28in Lg 2.00 EA 2 0.006 $98.82 PN: 203-L Strap Chem Lite (Note: Lifesaving Systems) 2.00 EA 1.6 0.16 $20.60

PN: 276-000-001 Suction Ambu Res-Cue Hand Pump (Note: Ambu Corp) 1.00 EA 0.25 0.025 $54.95

6545009577650 Surgical Instrument Set Minor Surgery 2.00 SE 3.73 0.2656 $304.48 TOT WEIGHT 97.3 TOT CUBE 8.8286 TOT COST $5,027.67

NSN NOMEN QTY UI TOT W TOT C TOT PRICE

MEDICATIONS 6505011277946 Bupivacaine Hcl Inj .50% 30ml Vial 10s 0.20 PG 1.688 0.01 $2.75 6505012426532 Cefotetan Disodium Sterile 2gm Vial 10s 0.50 PG 4.625 0.1825 $896.07 6505015053476 Diazepam Inj 5mg/Ml 2 Ml Cartridge Unit 10s 0.02 PG 0.011 0.0024 $0.47 6505001487177 Diphenhydramine Hcl Inj 50mg/Ml 1ml Syr 10s 0.02 BX 0.005 0.00066 $0.22 6505007341026 Epinephrine Inj USP 1mg/Ml 1ml Ampul 10s 0.02 PG 0.005 0.00024 $0.09 6505015034855 Gatifloxacin 400mg Tab Blister Pack 100s 0.10 PG 0.055 0.012 $64.20 6505012811247 Hespan In Sodium Chloride Inj 500ml Bag 12s 0.17 PG 2.72 0.085 $50.17 6505013391909 Ketamine Inj 10ml Vial 10s 0.50 PG 0.025 0.001 $21.27

6505013874095 Ketorolac Tromethamine Injection USP 30mg/Ml 1ml Unit 10/Package 0.20 PG 0.27 0.003 $11.92

6505005843131 Lidocaine Hydrochloride Jelly USP 2% 30ml 1.00 PG 0.15 0.006 $7.60 6505012444736 Midazolam Hcl Inj 5mg/Ml 1ml Vial 10s 0.50 PG 0.09 0.004 $31.51 6505015055813 Morphine Sulfate Inj 10mg 1ml Cart-Ndl 10s 0.50 PG 0.575 0.075 $6.21 6505000797867 Naloxone Hcl Inj USP .4mg/Ml 1ml Amp 10s 0.50 BX 0.06 0.025 $2.43

6505013876735 Promethazine Hydrochloride Injection USP 25mg/Ml 1ml Unit 10/Pg 0.50 PG 0.575 0.006 $4.66

6505014622436 Sodium Chloride Injection 0.9% 1000ml Bag 12s 0.17 PG 1.4348 0.0204 $1.43 6505014716410 Succinylcholine Chloride 100mg/Ml 10ml Vial 25s 0.08 PG 0.1 0.028 $5.55 6505012580983 Vecuronium Bromide Inj 10mg/Ml 10ml Vial 10s 0.20 PG 0.09 0.006 $28.55

CONSUMABLES

6510002035000 Adhesive Tape Surgical 3in X 5yd 2.00 SL 0.7 0.026 $5.60 6515013215211 Airway Kit Percutaneous Emergency Adult 1s 1.00 EA 0.2 0.05 $186.68 6515011676637 Airway Nasopharyngeal Robertazzi 30fr 12s 0.50 PG 1.5 0.1 $29.62 6515009582232 Airway Pharyngeal Berman Design 80mm 12s 0.17 PG 0.0442 0.00442 $0.54 PN: 000 172 002 Ambu Tubechek-B (Bulb Version) 20s 0.25 PG 0 0 $21.25 6510015032109 Bandage Elastic 8x10" Compressed Sterile (Cinch Tight) 16.00 EA 8.96 1.92 $63.52 6510009355823 Bandage Elastic Rolled Ace 6inx4.5yds 12s 0.83 PG 2.6975 0.23572 $17.55 6510000583047 Bandage Gauze Kerlix 4.5in X 4yds 100s 0.16 PG 0.184 0.00416 $15.77 6510002011755 Bandage Muslin Camouflage 37x37x52in 1s 16.00 EA 2.08 0.128 $32.80 6135009857845 Battery Nonrechargable 1.5v AA 24s 0.50 PG 0.05 0.0005 $3.76 6135008264798 Battery Nonrechargable 1.5v AAA 24s 0.50 PG 0.1 0.001 $1.63 7210009356665 Blanket Casualty 84x56in Plast Solid Tapd 4.00 EA 3.08 0.28 $23.84 PN: 276-000-010 Canister Suction W/ Catheters Ambu Res-Cue 10s 0.20 PG 0.02 0.002 $19.80 6515013909627 Catheter & Needle Unit IV 14gax1.25in 200s 0.05 PG 0.285 0.0016 $23.55 6515013909654 Catheter & Needle Unit IV 18gax1.25in 200s 0.04 PG 0.9 0.00572 $15.75 6515013909650 Catheter & Needle Unit IV 20gax1.25in 200s 0.05 PG 1.155 0.00715 $24.65

6515011069054 Connector Tubing Iv Inj Set J-Loop Flex Ext Tube Plas Ster 200s 0.01 PG 0.02 0.002 $2.14

6530014686154 Container Disposal Sharps Shuttle 24s 0.04 PG 0.12 0.01 $2.04 6510014575844 Dressing Burn 8x18in W/Water-Gel 20s 0.20 PG 0.11 0.024 $20.60 6510014081920 Dressing Chest Wound Seal Asherman 10s 0.80 PG 1.24 0.0096 $80.57 6510002017425 Dressing First Aid Field Camo 11x12in 4.00 EA 2 0.152 $20.80 6515011602537 Electrode Electrocardiograph 30s 0.20 PG 0.1 0.018 $3.33

6515015217505 Glove, Patient Examining & Treatment Sz Lg Olive Drab 50s (Note: Boundtree Medical) 0.50 PG 0.1 0.1 $4.13

6515015217501 Glove,Patient Examining Sz Med Olive Drab 50s (Note: Boundtree Medical) 0.50 PG 0.1 0.1 $4.13

6510014999285 Hemostatic Pack Wound 5x7in Pkg Quick Clot 1s 4.00 EA 0.32 0.24 $39.40 6515014697217 Holder Tube Endo Tracheal Thomas Sti 1s 6.00 EA 3.3 0.72 $2,040.00 6515014530960 Infusion Set Fluid Intraosseous F.A.S.T. 1s 1.00 EA 0.2 0.02 $95.00

NSN NOMEN QTY UI TOT W TOT C TOT PRICE 6515011050614 IV Inj Set Macrodrip 15 Drops/Ml 50s 0.12 PG 0.015348 0.003348 $9.64

PN: 351202 IV Start Kit Latex Free 1s (Note: Boundtree Medical) 10.00 EA 0.1 0.1 $18.00 8405008893683 Liner Poncho (Tri-Service Approved Blanket) 4.00 EA 2 0.06 $129.80 6505001117829 Lubricant Surgical 5 Gram 144s 0.07 PG 0.1442 0.00455 $0.50

7520013964722 Marker Tube Type Black Permanent Ultra Fine Point Sharpie 12s 0.33 PG 0.132 0.00033 $4.71

6515013419329 Mask Face Cardiopulmonary Resuscitation Clear Plas Nonster Disp 2.00 EA 0.02 0.002 $10.52

6515008886122 Mask Oronasal Semi-Rigid Translucent 50s 0.04 PG 0.22 0.06 $1.67 6515011727650 Needle Hypo Gp 22ga 1.5in Lg Luer Lock 100s 0.10 PG 0.048 0.05 $0.44 6510007863736 Pad Prep Isopropyl Alcohol Impreg 1x2.5in 100 0.50 PG 0.25 0.05 $1.29

PN: 9100-1012 Pads Defibrillator Multifunction 1pr (Note: Access Cardiosystems) 1.00 PR 0.2 0.02 $66.00

7520009357136 Pen Ball-Point Retractable Med Pt Black 0.17 DZ 0.0612 0.02448 $0.86 8520013535671 Skin Cleanser 60pct Alcohol No Rinsing 0.08 PG 0.72 0.04 $3.07 6515015096866 Sling, Pelvic Fracture Stabilizer 1s 1.00 EA 0.12 0.08 $50.00 6515012254681 Splint Malleable Alum 36x4.5in 12s 0.30 PG 1.5 0.144 $10.23 6510001161285 Sponge Surgical 12-Ply 4x8in White 80s 0.75 PG 18.75 3.75 $128.87 6515013948327 Stylet Tracheal Tube 7.5-10mm Plas Disp 10s 0.40 PG 0.84 0.0084 $16.36

6515014663004 Support Cervical Plas Univ Olive Drab (P/N: 000 281 000mil) 0.07 PG 0.0455 0.00105 $25.45

6515014520465 Syringe & Needle Vanish-Point 3cc 23ga 100s 0.10 PG 0.06 0.07 $8.24 6515007540412 Syringe Hypo Gp 10ml Cap Luer Slip 100s 0.10 PG 0.58 0.057 $1.90 6515014570288 Syringe Irrigating 60ml Luer Plas Disp 120s 0.03 PG 0.0375 0.0075 $3.03

PN: 732219 Tag Incident Military Mass Casualty Kit (Note: Boundtree Medical) 1.00 PG 0.25 0.2 $35.00

5640014620102 Tape Duct 2in X 60 Yards Black Industrial Grade 1.00 RO 0.55 0.12 $7.45 6515015002974 Tourniquet Self Applied Tourniquet System 1s 2.00 EA 0.62 0.062 $25.90 6515010369034 Tube Endotracheal Murphy 7.5mm 10s 0.20 PG 0.24 0.052 $4.59 6515001050759 Tube Endotracheal Murphy 8.0mm OD 10s 0.20 PG 0.2 0.01 $4.12 6515001490316 Tube Stomach Surgical Plastic Salem 50s 0.04 PG 0.16 0.028 $7.37 6515014211388 Tube Tracheal Esophageal Combitube 41 Fr 4s 0.25 PG 0.25 0.005 $51.07

6515013625805 Valve Oronasal Mask One-Way Valve Used w/Laerdal Pocket Mask 10s 0.20 PG 0.02 0.0002 $9.37

TOT WEIGHT 70.18 TOT CUBE 9.64 TOT COST $4,568.98

LONG-RANGE CASEVAC SUPPLEMENT

NSN NOMEN QTY UI TOT W TOT C TOT PRICE MEDICATIONS

6505009635355 Dexamethasone Sod Phos Inj 4mg/Ml 5cc 2.00 VI 0.16 0.006 $0.92

PN: 02-08-70 Oxygen 3000psi Ballistic Safe Carbon Fiber D Tank (Note: Boundtree Medical) 4.00 EA 14.8 1.2 $1,900.00

Subtotals 14.96 1.206 $1,900.92 CONSUMABLES

PN: 9100-2020 Battery AED Replacement 1s (Note: Access Cardiosystems) 1.00 EA 0.5 0.05 $90.00

6515001490104 Catheterization Kit Urethral 16fr Disp 2.00 EA 1.42 0.508 $12.96

PN: CPR-24 Circuit Vent Extension W/ Filter & Swivel (Oxylator) 25s (Note: Lifesaving Systems)

0.16 PG 0.04 0.0032 $14.40

6515014773259 Filter Viral/Bacterial Single Use (Oxylator) 50s (Note: Lifesaving Systems)

0.08 PG 0.1 0.02 $2.80

Subtotals 1.56 0.5312 $30.16

EQUIPMENT

PN: 9100-5001B Defibrillator Automatic W/Override (Note: Access-ALS Fr Access Cardiosystems)

1.00 EA 2.8 0.28 $1,689.00

6515014322711 Monitor Patient Vital Signs Propaq 206el 1.00 EA 25 2.4 21277.8

PN: D2301 Regulator Oxygen Gas 1 Port Tactical (Note: Boundtree Medical) 2.00 EA 3 1 152

6515014652119 Resuscitation And Inhalation System Oxylator Em-100 2.00 EA 2.5 0.5 1550

6515013737292 Thermometer Clinical Human Oral Digital 1.00 EA 0.01 0.001 9.5

6515013469186 Traction Apparatus Kendrick F/Immobilization 1.00 EA 1.25 0.08 107.93

Subtotals 31.76 3.981 $23,097.23 TOT WEIGHT 48.28 TOT CUBE 5.72 TOT COST $25,028.31

REPORT DOCUMENTATION PAGE

The public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB Control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. Report Date (DD MM YY) 17-Nov-04

T 2. Report Type nal

3. DATES COVERED (from - to) n/a

4. TITLE AND SUBTITLE Marine Corps CASEVAC: Determining Medical Supply Needs for Long- and Short-Range Airborne Casualty Evacuation 6. AUTHORS Martin Hill, Mike Galarneau, Gerry Pang, Paula Konoske

5a. Contract Number: 5b. Grant Number: 5c. Program Element: 63706N 5d. Project Number: M0095 5e. Task Number: 005 5f. Work Unit Number: 60304

7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Naval Health Research Center P.O. Box 85122 San Diego, CA 92186-5122

9 PERFORMING ORGANIZATION REPORT NUMBER Report 04-32

10. Sponsor/Monitor's Acronyms(s) BuMed/MARCORSYSCOM

8. SPONSORING/MONITORING AGENCY NAMES(S) AND ADDRESS(ES) Chief, Bureau of Medicine Marine Corps Systems Command and Surgery 2006 Hawkins Avenue Code M2 Quantico, VA 22124-5010 2300 E St NW Washington DC 20372-5300

11. Sponsor/Monitor's Report Number(s)

12. DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release; distribution is unlimited.

13. SUPPLEMENTARY NOTES

14. ABSTRACT (maximum 200 words) Historically, Marine Corps casualty evacuation (CASEVAC) missions have been lifts of opportunity, in which wounded were evacuated by any available rotor-wing aircraft, regardless of whether it carried medically trained personnel. In recent years, the Marine Corps adopted a “designated” CASEVAC system in which certain aircraft are assigned casualty evacuation as one of their missions and are crewed by at least one field-qualified corpsman. However, the equipping and training of these corpsmen is currently done on an ad hoc basis, and differs from unit to unit. In 2003, the Naval Health Research Center (NHRC) was tasked with analyzing and identifying the medical supply requirements for a long-range CASEVAC capability for the Marine Corps. Thirty-one generic CASEVAC patient types were developed from the Defense Medical Standardization Board’s list of patient conditions. Treatment profiles were written for each patient type and medical supplies were assigned to each task in the treatment profiles, establishing the clinical requirements for the CASEVAC supply blocks. A statement of need (SON) for a CASEVAC capability was written, based on the NHRC findings. The NHRC CASEVAC supplies and the SON were reviewed and modified as needed by an Integrated Product Team consisting of senior CASEVAC corpsmen and medical directors. The NHRC study and subsequent expert review have provided the Marine Corps with the medical supplies needed to properly augment its designated CASEVAC aircraft in Iraq and elsewhere.

15. SUBJECT TERMS medical supplies, AMAL, Surgical Company, operational medicine, Marine Corps 16. SECURITY CLASSIFICATION OF: 19a. NAME OF RESPONSIBLE PERSON

Commanding Officer a. REPORT

UNCL

b. ABSTRACT UNCL

b. THIS PAGE UNCL

17. LIMITATIONOF ABSTRACT

UU

18. NUMBER OF PAGES

19b. TELEPHONE NUMBER (INCLUDING AREA CODE) COMM/DSN: (619) 553-8429

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